💼 Practice Management
Billing, coding, and business essentials for NPs
E/M Codes (Office Visits)
Evaluation and Management codes for outpatient visits
💡 Tips:
- 2023 rules: Time-based billing OR medical decision-making (MDM)
- Total time includes pre-visit prep, face-to-face, and post-visit documentation
- Incident-to billing requires physician presence in suite
- Check payer rules - some require NP to bill under own NPI
Medicare
85% of physician rate (or 100% with incident-to)
- Must bill under own NPI for 85% rate
- Incident-to requires: established patient, physician-established plan, physician in suite
- Cannot bill incident-to for new patients or new problems
Medicaid
100% in most states (varies by state)
- State-dependent rules
- Some states require collaborative agreement
- Enrollment process varies
Commercial Insurance
80-100% of physician rate (varies by contract)
- Credentialing required (can take 3-6 months)
- Contract negotiation possible
- Some plans reimburse NPs at lower rates
Legal & Business Structure
Choose business entity
LLC, PC, or sole proprietorship (consult attorney & CPA)
Register business with state
Articles of incorporation, EIN from IRS
Obtain licenses
NP license, DEA, state controlled substance license
Malpractice insurance
Own-occurrence policy (NOT claims-made if you're independent)
Business insurance
General liability, property, cyber liability
Physical Space
Find location
Office space, shared suite, mobile practice, or telehealth-only
Office equipment
Exam tables, chairs, medical supplies, computer
Medical supplies
Diagnostic equipment, medications, first aid
Office supplies
Paper, printer, phone system
Technology & Systems
EMR system
Athenahealth, DrChrono, SimplePractice, eClinicalWorks
Practice management software
Scheduling, billing, patient portal
Website
Professional website with online booking
Phone system
HIPAA-compliant, call routing, voicemail
Credentialing & Contracts
NPI number
Individual NPI (you have this) + organizational NPI if applicable
CAQH profile
Required for insurance credentialing
Insurance credentialing
Apply to each payer (Medicare, major commercial plans)
Contract negotiation
Negotiate reimbursement rates if possible
Marketing & Growth
Google My Business
Free listing, crucial for local SEO
Social media presence
Facebook, Instagram (HIPAA-compliant posts)
Networking
Referral relationships with physicians, specialists
Launch promotions
New patient specials, community events
Minimal Start (Telehealth-Only)
$10,000
Assumes home office, telehealth visits only, minimal overhead
Moderate Start (Shared Office Space)
$50,000
Assumes shared office space, part-time, gradual patient build
Full Launch (Independent Office)
$124,000
Assumes independent office, full-time, hiring staff
❌ Under capitalization
Why it's a problem: Running out of money before practice is profitable
✅ How to avoid: Have 6-12 months operating expenses saved; start part-time while keeping other job; don't quit until you have patient pipeline
❌ Poor location choice
Why it's a problem: Not enough patient traffic or wrong demographics
✅ How to avoid: Research area demographics; consider competition; ensure good visibility and parking; test with temporary space first
❌ Not understanding insurance
Why it's a problem: Losing money on poorly reimbursed plans
✅ How to avoid: Research payer mix in area; negotiate contracts before accepting plans; understand fee schedules; consider cash-pay model
❌ Trying to do everything yourself
Why it's a problem: Burnout and inefficiency
✅ How to avoid: Hire help early (even part-time); outsource billing/credentialing; use virtual assistants; focus on your clinical strengths
❌ Not marketing enough
Why it's a problem: Empty schedule for months
✅ How to avoid: Start marketing 3+ months before opening; build referral relationships; strong online presence; consider patient acquisition cost
❌ Inadequate systems
Why it's a problem: Billing errors, missed appointments, HIPAA violations
✅ How to avoid: Invest in good EMR; have clear policies and procedures; get practice management consultant if needed